Thursday, January 31, 2013

This mom has graciously (and proudly!) given permission for us to share these birth photos with you. This was her 5th baby, and very first natural birth. After 4 hospital births (3 of which were elective inductions, and all with an epidural), she decided that she wanted something different. She looked back at her previous birth (her 4th baby) and realized that she had wanted to experience it without medications or an epidural, but simply chose to get an epidural at the last minute, out of fear... And so she would go on to deliver at a free-standing birth center, with I as her midwife, and Glen (her obstetrician!) as her birth photographer. It was a beautiful waterbirth!

Disclaimer: This blog post contains photos of birth, and therefore has nudity. If you do not wish to see it, do not view this blog further. Consider yourself warned. : )

Our practice name and description say it well- Integrated Women's Wellness. "We are an integrated, collaborative Physician-Midwife team, who bring together our individual knowledge and skill to create a beautifully blended model of care."

In our practice, I meet with every newly pregnant mom for her initial appointment. I love to be able to personally welcome every new patient. At this appointment we discuss the patient's medical history, discuss any relevant pregnancy concerns and precautions, obtain labs, and lastly, discuss the practice philosophy and options for care. Patients have the option of midwifery care, physician care, or a blend of both. Depending on their history and risk factors, many also have the option for hospital, birth center, or home birth.

For those who have never heard of or considered midwifery care or Out-Of-Hospital birth, sometimes this is a hard thing to comprehend. Wait a minute. 'Out-Of-Hospital?' Like, as in, have the baby NOT in the hospital? Birth at a birth center? At HOME????? With a what (that would be Mid-wife)? Without a DOCTOR!? Mind.Blowing.Stuff. In today's era, it's not uncommon for women and their partners to have never been exposed to what a midwife is. You get pregnant. You go see the doctor. You have your baby at the hospital. (And, if you're lucky, about 67.2% of the time, you end up with a vaginal birth.)

There is an upward trend in more and more new patients coming in who are inquiring about midwifery care and birth options from the get go (before I even have the opportunity to mention it). {On a side note: Interestingly, included in this upward trend of women inquiring and choosing Out-Of-Hospital birth, within my clientele I have a physician, Registered Nurse, and the wife of a physician.} But still, for every one of those, there are still others that say things like "No way, I want to be in the hospital, in case there's a complication," or, "I want to be at the hospital, where it's safest." And lastly, with the first-time moms I often hear, "I very much want midwifery care and a birth center birth, but I think for my first baby, I'll go to the hospital to be safe. If everything goes well, I'll do an Out-Of-Hospital birth next time." We support women in having options for their birth- that in essence is what we are about- but, it is still hard for my midwife ears to hear (knowing the statistics for hospital birth as well as OOH birth)!

So to those who may speak the same words or think those same thoughts and have apprehension or questions about the safety of birth centers (and Out-Of-Hospital birth in general), Check out the link below to the just-released study, Outcomes of Care in Birth Centers: Demonstration of a Durable Model.

These quotes sum it up and say it well:

"The cesarean birth rate in this cohort study was 6% versus the estimated rate of 25% for similarly low-risk women in a hospital setting. Had this same group of 15,574 low-risk women been cared for in a hospital, an additional 2934 cesarean births could be expected."

"There were no maternal deaths. The intrapartum fetal mortality rate for women admitted to the birth center in labor was 0.47/1000. The neonatal mortality rate was 0.40/1000 excluding anomalies."

"The intrapartum fetal and neonatal mortality rates found in this study are comparable to those reported in many studies of low-risk women."

"This study demonstrates the safety of the midwifery-led birth center model of collaborative care as well as continued low obstetric intervention rates, similar to previous studies of birth center care. These findings are particularly remarkable in an era characterized by increases in obstetric intervention and cesarean birth nationwide."

So for safety's sake, consider this: If you are trying to avoid unnecessary intervention and avoid a cesarean section, planned Out-Of-Hospital birth has been shown to be a safe option. While we continue to support our moms that truly desire to be in the hospital, we will also recognize the growing evidence that Out-Of-Hospital birth is a safe and good option, both for moms and for babies.

The study can be found here:
http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12003/full

Saturday, January 26, 2013

It's official! After months of searching, researching, and corresponding with various organizations, we have decided on a location and organization, and are excited to announce that we will be making a nearly month long trip to Haiti, with the organization Midwives for Haiti.

The desire to learn more and have a greater understanding of all things has always been insatiable within me. For both Glen and I- as a doctor and a midwife, the need for learning is constant. Over the last few months, the desire to learn more and understand more, specifically about the variation of birth practices and birth outcomes, has grown within me. I was able to make the trip this past fall to Bad Wildbad, Germany, to attend the 2012 Midwifery Today conference. I was honored to be surrounded by midwives from countries all around the world, all with such common desires and goals, but still so uniquely varying- both individually and culturally. I left that quaint German town with a deeper understanding of birth from a global perspective. At the very basic level, we are caring for women and babies...but as I got a glimpse of, there is so much more that influences those practices.

Here at home in Alaska, as women's care providers and birth professionals, we strive to practice evidence-based and support normal, physiological birth. Glen and I are just two people in a growing army of birth professionals, advocates, and consumers across the state and across the United States, that see the detriment of the astronomical rate of interventions and technologies that are routinely used, and the complications that arise from such.

What is interesting and perplexing, is the varying outcomes of developed countries compared with other developed countries, as well as developed countries compared with underdeveloped countries. While we are struggling to lower our intervention rate and change our high-tech, routinely interventive ways as a means to improve our maternal and fetal outcomes, there are countries who have the opposite problem- mothers and babies are dying due to not only the lack of technology and intervention, but due to the lack of adequate nourishment, prenatal care, basic supplies needed for birth, and lastly, skilled birth attendants. In other words, women are malnourished, lacking basic prenatal care, and left to deliver their babies alone or with an attendant who is lacking any formal training. As I sit here and type from the Embassy Suites, with my family on a "stay-cation" so that we can have a weekend of movies, snacks, and swimming in the indoor pool, my Cadillac Escalade sits in the parking lot, with a packed birth kit, fully equipped with a fetoscope, doppler, birth instruments, suturing instruments, resuscitation equipment, and (when it's not 5 degrees outside) IV kits and antihemorrhagic meds. And I see the wrongness in that.

I think of the lives that could be saved from that single bag. Or with the knowledge and skill Glen and I have to give. Or even better- the knowledge and skill we can share and pass on in teaching other birth attendants. And so, being do-ers and not talkers, and putting aside the shoulda' coulda' woulda's and excuses, we have jumped in and committed ourselves to supporting Midwives for Haiti. We are so very excited. We have so much to share and teach and give and learn.
And so we ask for your help- because we cannot, nor want, to do this on our own. We need your help. We would like your sponsorship in helping to pay for the expense of the trip and for the supplies that we will be taking on our journey. Instruments, ant-hemorrhagic medications, antibiotics, IV kits, disinfectants...the list goes on. Whatever we can bring, we will. But we need money in order to bring these much needed, life-saving supplies.

We ask you to donate in support of our trip to Haiti, but we would love it if you could take it a step further and consider committing to fundraise on behalf of Midwives For Haiti. If we each spread the word and reach out into our community, we have no doubt that this community can succeed in making this the trip of a lifetime, that will benefit many, many women, babies, and families!

To donate, please go to http://midwivesforhaiti.org/index.php/donate-m4h
So that the organization may know that it is in support of our trip, please put "Team Elrod" in the 'Notes' section.